Qualified Plan Certification Form
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QUALIFIED PLAN CERTIFICATION
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Title of Plan:
Plan Tax ID:
Plan's Original Effective Date:
Name of Trustee:
Name of Trustee:
Name of Trustee:
Name of Trustee:
A copy of the Plan's Internal Revenue Service determination letter must be furnished with this document.
As Trustees of the above Plan and its related trust, and in connection with our application to open and maintain a securities brokerage account
with Scottrade, Inc., (Scottrade) on behalf of the Plan, the undersigned hereby represent and warrant that:
1. The Employer has established the Plan by contracting with a retirement plan sponsor and formally adopting a prototype plan, or otherwise
established the Plan with the assistance of an appropriately qualified third party.
2. The Plan is a tax-exempt qualified plan as defined by the Employee Retirement Income Security Act (“ERISA”) or the Internal Revenue Code
(the “Code”).
3. The undersigned Trustees are all the present Trustees of the Plan and are duly authorized under the documents governing the Plan and trust
and applicable law to: (a) enter into the Scottrade Brokerage Account Agreement on behalf of the Plan; (b) open and maintain one or more
Scottrade brokerage accounts for the Plan; (c) enter into transactions for the purchase, sale or exchange of securities and other investments,
including, but not limited to, stock (common or preferred), fixed income products, exchange traded funds, mutual funds and certificates of
deposit; (d) execute or provide any required document in connection with the Scottrade brokerage account on behalf of the Plan; and (e) if the
Plan permits, to engage in options transactions on behalf of the Plan, upon Scottrade's approval of the Plan's account for options, pursuant to
the options rules and requirements as set forth by Scottrade.
4. Entering into the Scottrade Brokerage Account Agreement and the transactions contemplated hereunder do not and will not constitute
nonexempt prohibited transactions under Section 406 of the Employee Retirement Income Security Act (“ERISA”) or Section 4975 of the
Internal Revenue Code (the “Code”) by reason of ERISA section 408(b)(17), or another applicable exemption.
5. The documents governing the Plan and its related trust do not prohibit or restrict the Plan from opening a Scottrade brokerage account or
transferring all or a portion of the Plan's assets to such Scottrade brokerage account. Further, the documents governing the Plan and its
related trust do not include any provisions that would terminate or cause the Plan or trust to be disqualified under the Internal Revenue Code
upon transferring all or a portion of the Plan's assets from the Plan's current broker or other custodian.
6. The documents governing the Plan and its related trust do not prohibit or restrict the Plan from entering into any securities or other investment
transactions that will be entered into on behalf of the Plan through the Plan's Scottrade brokerage account.
7. The undersigned acknowledge that they are responsible for ensuring that neither the Scottrade Brokerage Account Agreement, nor any
transaction hereunder will violate any applicable law, rule, regulation, or document applicable to the Plan, including, without limitation, ERISA
or the Code.
8. Sufficient assets of the Plan are and shall be available to satisfy the Plan's obligations under the Scottrade Brokerage Account Agreement.
9. The undersigned understand and agree that Scottrade acts only as a custodian of assets and a broker for securities transactions and that
Scottrade is not a fiduciary, trustee, investment manager, or plan administrator of the Plan, and has no duty to advise and does not advise the
Plan or the undersigned regarding any issues or matters related to the initial or continued qualification of the Plan or to perform any functions
of a fiduciary, trustee, investment manager, or plan administrator including, but not limited to, providing investment advice or investment
management services, actuarial services (including advice with respect to the Plan's funded status), tax reporting, or any function to maintain
the Plan's qualified status under the Internal Revenue Code. The undersigned further understand and agree that Scottrade is not subject to
the duties or standards governing the conduct of fiduciaries, trustees, investment managers, or plan administrators.
10. The undersigned understand and acknowledge that Scottrade is relying upon the representations and warranties contained in this document in
accepting, opening and maintaining the Scottrade brokerage account for the Plan and will notify Scottrade in writing of any changes to the
information, representations and warranties contained herein; certain changes to the information contained herein may require new account
paperwork be completed and submitted for review and approval by Scottrade.
The undersigned agree that the Plan will indemnify and hold Scottrade, its officers, directors, employees, agents and assigns harmless from any
loss, damage or claim arising as a result of Scottrade's reliance on the information provided in this document, any breach of ERISA, the Code,
other applicable law, or the governing Plan documents on the part of the undersigned (or their affiliates or agents), or from Scottrade's acting upon
instructions believed by Scottrade to have originated with the Trustees, or an authorized representative of the Trustees. The undersigned agree to
abide by the Scottrade Brokerage Account Agreement and all other applicable Scottrade agreements.
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Trustee Signature
Trustee Signature
Date
Date
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*SF1025*
Date
Trustee Signature
X
Date
Trustee Signature
SF1025/3-15
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